RECORD OF PROCEEDINGS IN THE CASE OF: BOARD DATE: 13 May 2008 DOCKET NUMBER: AR20070018489 I certify that hereinafter is recorded the true and complete record of the proceedings of the Army Board for Correction of Military Records in the case of the above-named individual. Director Analyst The following members, a quorum, were present: M Chairperson M Member M Member The Board considered the following evidence: Exhibit A - Application for correction of military records. Exhibit B - Military Personnel Records (including advisory opinion, if any). THE APPLICANT'S REQUEST, STATEMENT, AND EVIDENCE: 1. The applicant requests correction of her Physical Evaluation Board (PEB) findings to show that her medical condition was aggravated by military service and, in effect, medical retirement. 2. The applicant states that her systematic lupus erthematosis (SLE) illness was aggravated by military service. 3. The applicant provided additional documentary evidence through counsel. COUNSEL'S REQUEST, STATEMENT AND EVIDENCE: 1. Counsel requests, in effect, reversal of the applicant’s PEB findings from “existed prior to service (EPTS) without aggravation” to “aggravated by service” and correction of her records to show she was medically retired instead of discharged. 2. Counsel states: a. the applicant served honorably for about 7 years, performed all tasks assigned to her including her fitness test, and was commended as an outstanding officer. The Army knowingly allowed her to enter active duty with SLE, but failed to properly evaluate her condition to determine her physical status or work restraints. If she was evaluated or given the necessary provisions for service, she would have been able to continue her service until retirement. Instead, the Army required her to work long days which permanently aggravated her disease. The applicant’s doctor performed a meta-analysis of her medical records and concluded that her condition was exacerbated by her service; b. before a Medical Evaluation Board (MEB) can rule that a Soldier’s permanent disability was not caused by military service, the MEB must make specific conclusions based on established principles that must be soundly rooted in the medical field rather than opinions; c. the Army required the applicant to work in excess of a standard duty day. The Army evaluated her in October 1999 because of her SLE and determined she did not warrant any duty limitations. She was not issued a physical profile until May 2001 that, in effect, limited her physical activity. In late 2005, her rheumatologist opined at her MEB that her SLE condition made her not compatible with active duty service; d. there is no basis to the PEB’s findings. The PEB did not clearly indicate, based on established medical principles, if her condition was exacerbated by military service. Her military doctor did not give an opinion why she was able to perform to standard upon entering active duty but experienced a systematic and functional decline over the course of her career. The PEB concludes that the applicant’s symptoms were consistent with the natural progression of SLE without any supporting evidence; and e. the applicant’s health declined due to military duties; not her medical condition. The extra rigors of military service and high physical requirements affected her condition. The Army brought her on active duty without a waiver and did not make any provisions for her medical condition until it was too late. By the time she was deemed non-deployable and was instructed to work a limited schedule, her condition had already been aggravated by her military service. 3. Counsel provided the following additional documentary evidence in support of the applicant’s request: a. Medical Statement, dated 20 May 1999, from the Director of Rheumatology at the University of Texas Medical Branch at Galveston, Galveston, Texas; b. DA Form 705 [Army Physical Fitness Test (APFT) Scorecard], dated 11 February 2005; c. DA Form 67-9 (Officer Evaluation Report), for the period 20030629 to 20040614; d. Affidavit, dated 28 September 2007, from the applicant's medical doctor who is certified in rheumatology; e. DA Form 3349 (Physical Profile), dated 23 May 2001; f. Standard Form 600 (Chronological Record of Medical Care), dated 26 October 2004; g. DA Form 199 [Physical Evaluation Board (PEB) Proceedings], dated 1 December 2005; and h. DD Form 214 (Certificate of Release or Discharge from Active Duty), dated 10 May 2006. CONSIDERATION OF EVIDENCE: 1. The applicant's records show that she was appointed as a Reserve commissioned officer in the rank of second lieutenant (2LT) on 5 June 1992, executed an oath of office on 4 July 1992, and was subsequently assigned to the U.S. Army Reserve Group [Officer Active Duty Obliger (OADO)]. 2. On 3 October 1992, the applicant submitted a request for the Health Professions Scholarship Program (HPSP). The HPSP is an Army program which offers full financial support in exchange for future service as a physician, dentist, nurse practitioner, or other specialty. Following verification of eligibility for a commission including physical and academic qualifications, the applicant was placed on inactive Reserve status while under fully funded training at the student's university. 3. The applicant was in HPSP status at the University of Texas, San Antonio, Texas, from 1992 to 1996, and had a deferred civilian pediatric residency from 1996 to 1999, at the University of Pittsburgh for internship and the University of Texas at Galveston for her second and third year residency. During this period of her residency, the diagnosis of SLE was made. 4. On 25 May 1996, the applicant was appointed as a Reserve commissioned officer in the Medical Corps of the USAR in the grade of CPT with 4 years of constructive service credit. She executed an oath of office on the same day. 5. On 20 May 1999, the Director of Rheumatology at the University of Texas Medical Branch at Galveston, Texas, Dr. Li___, stated that he had been caring for the applicant during her pediatric residency and that she carries the diagnosis of SLE. Her major manifestations of this disease included fatigue, migraine headaches, malar erythema, oral ulcerations, photosesitivity, a positive antinuclear test and that she also had mitral valve prolapse. The applicant’s symptoms were fairly controlled with the use of medications. However, due to her pregnancy at the time and the possibility of discontinuing some of her medications during pregnancy, there was a risk factor for exacerbation of her disease and that might have caused her disease to flare. 6. On 24 May 1999, the applicant was ordered to active duty as an obligated volunteer officer for a period of 4 years to fulfill active Army requirements. She was assigned to Madigan Army Medical Center, Fort Lewis, Washington, effective 16 July 1999. 7. On 23 May 2001, the applicant was issued a physical profile, citing a medical condition of hyperventilation syndrome and lupus erythematosis. The physical profile limited the applicant's walking, running, and cycling activities to own pace and distance. Subsequently, she underwent a Medical Military Occupational Specialty (MOS) Retention Board (MMRB) to evaluate her ability to perform in her specialty. 8. On 15 August 2001, the applicant's immediate commander submitted a performance statement to the MMRB President. He stated that the applicant's condition at the time precluded her from doing any tasks that required vigorous physical activities. However, she had no problem working regular, extended, or extra shifts, or completing any of the tasks associated with her job. He further stated that she had received a series of profiles related to her illness, and that she had been given preparation time to train for an alternate event on the next semi-annual APFT, and would be able to complete an alternate APFT. He recommended her retention in her MOS. 9. On 28 August 2001, a MMRB convened at Fort Lewis, Washington, and determined that the applicant was diagnosed with SLE in 1996 and that her condition caused her significant discomfort and fatigue when she was exposed to sunlight for extended periods. During the conduct of the MMRB, the applicant stated that her condition did not affect her everyday performance in the Department of Pediatrics and requested she be retained in her specialty. The MMRB noted that the applicant's condition did not prevent her from satisfactorily performing the duties of her specialty in a worldwide environment and as such, the MMRB recommended the applicant be retained in her MOS. The convening authority approved the findings and recommendation of the MMRB on the same day. 10. On 30 June 2002, the applicant was promoted to major (MAJ) and was subsequently reassigned to B Company, Brooke Army Medical Center, Fort Sam Houston, Texas. 11. On 7 June 2005, the applicant underwent a medical examination where she was diagnosed with “lupus.” The attending physician, Dr. Un___ further recommended specialty examinations for a right shoulder labrial tear, planter fasciitis, migraine, left foot Morton’s Neuroma, irritable bowel syndrome (IBS), anxiety, foot ganglion, and mitral valve prolapsed (MVP). 12. On 15 June 2005, Dr. Ba_________, conducted a thorough evaluation of the applicant's medical condition. He remarked that her SLE interfered with her successful performance of duty and required a permanent physical profile that made her non-deployable. She required chronic medical therapy and frequent follow-up with a rheumatologist and primary care. She experienced 3 to 4 flares per day, associated primarily with arthritis, oral ulcers, and symptoms of pleuritis. She was also referred for fibromyalgia with chronic non-restoring sleep and classic physical exam findings of fibromyalgia. This was secondary to and associated with her SLE. 13. On 20 July 2005, Dr. Fi___, Internal Medical Clinic, Brooke Army Medical Center, Fort Sam Houston, Texas, referred the applicant to Dr. Fu_______, for further medical evaluation. Dr. Fu_______ remarked that the applicant was diagnosed with vasospastic angina (variant angina). He further remarked that her angina with controlled symptoms was not cause for referral to the MEB. He recommended that this diagnosis be considered in addition to the principal diagnosis of SLE. 14. On 18 August 2005, a MEB convened at Fort Sam Houston, Texas, to evaluate the applicant’s medical condition. The MEB determined that the applicant was medically unfit for duty due to SLE and fibromyalgia. The MEB also found the applicant had the following medically acceptable conditions: depression, right shoulder labrial tear, patellofemoral pain, mitral valve prolapse with regurgitation, planter fascitis, right foot ganglion cyst, migraine headache, left foot Morton’s Neuroma, irritable bowel syndrome, Raynaud’s syndrome, and vasopastic angina. The MEB recommended the applicant be referred to a PEB. 15. On 28 September 2005, the Chief, Gynecology Service, Brooke Army Medical Center, Fort Sam Houston, Texas, submitted a memorandum for record stating that the applicant had been under his care since conception of her second child and that she had a history in her prior pregnancy of postpartum depression that resolved once she discontinued breastfeeding. Following the delivery of her second child in September 2004, she again developed postpartum depression that responded well to medication. The applicant continued to breastfeed and remained hypoestrogenic in light of her lack of menstruation to date. The Chief concluded that it was his expectation that once she discontinued breastfeeding and resumed normal menstrual cycle, she would also expect resolution of her depression. 16. On 20 October 2005, the applicant was informed of the MEB’s approved findings and recommendations. She elected not to concur with those findings and recommendations and further submitted an appeal. In her appeal statement, the applicant stated that although she was not on active duty at the time of her diagnosis with LSE, she was under obligation to serve in the Army. Upon entry into the Army, she made the Pediatrics Department aware of her condition. During her time on active duty, she was progressively limited in her ability to support the mission required by her MOS. She also stated that the chronic physical and psychological stress placed upon her by the Army required her to meet standards that she was not even able to meet upon entering the Army and had caused a significant exacerbation of her symptoms. She further requested reconsideration of the MEB’s findings to read “SLE, permanently aggravated by service.” 17. On 25 October 2005, the MEB’s approving authority indicated that he disagreed with the applicant’s argument that the word “obligated” meant the same like “incurred while eligible to basic pay” and that he would defer to the PEB to adjudicate the case with the applicant’s statement. 18. On 1 December 2005, a PEB convened at Fort Sam Houston, Texas, and found the applicant's condition prevented her from performing her duties and determined that she was physically unfit due to SLE, with secondary fibromyalgia manifested by non-restoring sleep pattern, greater than 11/18 trigger points, and fatigue; unable to work greater than 32 hours per week due to pain medication. The applicant was rated under the Department of Veterans Affairs Schedule for Rating Disabilities (VASRD) code 6350 disability rating. The PEB also stated that there is compelling evidence to support a finding that the applicant’s current condition existed prior to service and was not permanently aggravated beyond natural progression by such service. The applicant was initially diagnosed with SLE during her civilian pediatric residency prior to entering active duty in 1999. Her current symptoms were consistent with the natural progression of this disorder, including current symptoms of fibromyalgia, which, the rheumatologist indicates is likely secondary to and associated with her SLE. The PEB further recommended the applicant be separated from the Army without disability benefits. 19. The applicant did not concur with the PEB’s findings and recommendations. She waived a formal hearing and submitted a written appeal. 20. On 16 December 2005, she submitted a written appeal to the PEB stating that she was commissioned in the Army on 4 July 1992 under the HSPS and incurred an obligation to the Army over the subsequent 4 years (July 1992 to May 1996). Following medical school, she did not match into an Army training program due to a limited number of training slots and was thus deferred to complete a civilian residency. During her residency, she was diagnosed with SLE in November 1996. Although she was not on active duty at the time of her diagnosis, she was under obligation to serve in the Army. If she was not deferred, she would have been on active duty as an intern at the time of her diagnosis. Upon completion of her training in 1999, she made the consultant for Pediatrics and the graduate medical education branch aware of her condition. She was ordered to active duty although she did not meet fitness standards at the time. During her active duty service, the chronic physical and psychological stress placed upon her by the Army required her to meet standards that she was not even able to meet upon entering the Army and had caused a significant exacerbation of her symptoms. She concluded that her condition was permanently aggravated as evidenced by the fact that her symptoms were not alleviated by the removal of those requirements. 21. On 1 February 2006, the PEB reconvened and considered the applicant’s rebuttal statement as well as the medical evidence of record. Based on the review, the PEB found the applicant’s physical and medical impairments prevented reasonable performance of duties required by her grade and specialty. It further determined that the applicant’s state of unfitness was the result of natural progression of her disease which was not incurred while entitled to basic pay. She was initially diagnosed with SLE during her civilian pediatric residency prior to entering active duty in 1999. Her symptoms were consistent with the natural progression of this disorder, including the symptoms of fibromyalgia, which the rheumatologist indicated was likely secondary to and associated with her SLE. The PEB recommended the applicant be separated from the Army without disability benefits. Accordingly, by memorandum, the Chief Operations Division, U.S. Army Physical Disability Agency, Washington, D.C., informed the applicant that there was no change in the disposition of the PEB. 22. On 10 May 2006, the applicant was discharged from the Army. The DD Form 214 she was issued at the time shows she was honorably discharged for disability, existed prior to service, in accordance with paragraph 4-24b(4) of Army Regulation 635-40. This form further shows she completed 6 years, 9 months, and 26 days of active military service. 23. In an affidavit, dated 28 September 2007, Dr. Fe______, the applicant’s doctor stated that he was currently treating the applicant for her SLE condition and that based on his review of the medical records, it is evident that her SLE condition was exacerbated during her military service as a direct result of the duty she performed for the Army. He further states that she was initially diagnosed with SLE in 1996 after beginning her pediatrics residency. After entering the Army she was required to perform a full duty day. Generally speaking, a military physician can work in a clinic for 80 or more hours per week. Furthermore, during clinic time, a doctor is generally on her feet, examining patients and has very little time to rest. The applicant was exhausted by her duties. Based on the review of her medical records, it was clear that there was a functional decline in her ability to work. Her energy level decreased and her SLE symptoms increased. Where she had been able to meet standards on the Army physical fitness test, by the end of her tenure in the Army she was unable to do so. Furthermore, she could only conduct rounds in the clinic for 32 hours per week and was rated non-deployable. He concludes that he finds her condition upon discharge was a result of aggravated SLE. SLE is a disorder in which the patient may present typical symptoms one day, yet have no active disease on the next day. Thus, to determine if her condition was exacerbated by her service, a doctor must perform a meta-analysis of her records and that he has done that and found her unable to function in the way she did when she first entered active duty. She continues to be limited by her daily activities, such as being able to only work 32-hour work week. 24. In an advisory opinion obtained in the processing of this case on 27 February 2008, the legal advisor, U.S. Army Physical Disability Agency, Washington, D.C., recommended the applicant’s military records remain unchanged. He stated that: a. the applicant’s request for correction of her records indicated that she is of the opinion that the PEB erred when it found that her EPTS condition of SLE was not permanently aggravated by military service; b. the applicant was diagnosed with SLE in November 1996. There was no evidence presented which would indicate she had SLE in her prior active duty period. In 1999, she entered active duty and continued to have SLE at that time. After she gave birth to her second child in the fall of 2004, her condition worsened and it was felt that her flares had become too consistent to allow her to continue to work full time. During her pregnancy, and afterward because of breastfeeding, she could not take normal controlling medications. Her primary complaint in 2005 was “flares of arthritis, oral ulcers, pleuritis, and fatigue”; c. on 1 December 2005, an informal PEB found her unfit for SLE, but considered it non-compensable because the condition was not incurred while entitled to basic pay under Title 10, U.S. Code, section 1201, and that her current state of unfitness was the result of natural progression of her EPTS condition. She non-concurred, but waived her right to a formal hearing. She submitted an appeal which stated that even though she was not on active duty when her SLE was incurred, she was obligated to serve in the Army after her civilian training. She further indicated that she believed her SLE was permanently aggravated while on active duty since 1999. The PEB reviewed the appeal, but found no new evidence which required a change to the PEB’s findings; d. the applicant’s petition to correct her records reiterates the same points of her appeal, that the military allowed her to reenter the Army knowing she had SLE and that her condition was aggravated by her military service. This petition is supported by comments from counsel and an affidavit from her physician. Her physician opined that her SLE was aggravated because she experienced a functional decline in her ability to work while in the Army; e. SLE is a chronic progressive disease process that is characterized by periods of illness, called flares. The natural progression of SLE is for it to get worse. It can often be managed by medication and good medical treatment, but individuals with SLE are always susceptible to flares and progression of the disease. The fact that her condition worsened over a 5 year period is certainly not unusual, nor can it be automatically found to be of permanent aggravation. Other factors that most likely caused exacerbation of her SLE are two child births; with resulting reduced required medications during pregnancy and afterwards. These factors were not permanent service aggravations of her SLE that would be above and beyond the normal progression under these circumstances. Whether she was a civilian or military physician, her condition would have most likely progressed in the same manner. The petition states that she did not have a profile when she first entered active duty on 1999. However, the MEB indicated that she entered on active duty in 1999 on a medical profile. She had continued review of her condition all throughout her active duty period and was specifically found fit for duty in 2001. It needs to be remembered that she is a physician and clearly knew the rules for medical retention standards and what was required in obtaining and preparing a medical profile. If the applicant felt she could not perform, all she had to do was request a profile. An opinion that her condition was worse when she left the Army in 2005 is certainly not a contested issue and that opinion by her physician provides little support for her allegation of PEB error; f. the PEB fully considered the applicant’s contention of service aggravation. The PEB could have done a better job explaining their rationale of natural progression in their findings, but support for such finding clearly exists in the very nature of normal SLE progression. A review of the applicant’s history of flares and slowly reduced work duties supports this finding of natural progression; and g. the fact that she was obligated for further military service because of her medical schooling does not establish her condition as service incurred or permanently aggravating. 25. The applicant was provided with a copy of the advisory opinion on 28 February 2008. She non-concurred with the advisory opinion and elected to submit a statement through counsel on 25 March 2008. In his statement on behalf of the applicant, counsel: a. restated the applicant's background and petition to change her records to show that her injury was exacerbated by her military service and that she should be retired; b. stated that the rheumatologist who examined her in preparation for her MEB failed to account for the decline in her abilities and that he simply noted that she was no longer capable of service. Counsel also added that the PEB failed to cite any medical literature or established medical principal regarding the conclusion. It simply referred to the record, which inevitably contained the rheumatologist's opinion and then concluded that there had been no exacerbation; c. stated that paragraph 3-2a(3) of Army Regulation 635-40 states that when determining whether a Soldier's condition has been exacerbated by her service, an evaluator must begin with the presumption of exacerbation; that is, the Army must prove that a Soldier's injuries were not made worse by the service and that the evidence should include objective details from the record and the conclusion must be based on sound medical principles. Sound medical principles are not mere opinions; d. stated that although there is a deference afforded to the PDA's decision; that decision must be made in a reasonable manner. Otherwise, the decision will be overturned as arbitrary and capricious. He further stated that there is simply no evidence that the natural history of SLE is a continual decline over a short 6 year period. In his advisory opinion, the PDA's legal advisor cited a pamphlet from the National Institute of Health (NIH) as authority to assert that SLE natural history is a progressive decline, but the legal advisor failed to attach the pamphlet and as such, counsel submits a copy to the Board; e. stated that the pamphlet asserts that SLE is a disease in which symptoms wax and wane and is characterized by periods of flares and remissions. Both rheumatologists agree on this principle. Patients with SLE will have good days and bad days. There is no medical literature that predicts that generally SLE patients will have more bad days than good, thus resulting in a progressive decline over the course of the disease; f. added that the NIH pamphlet notes that most patients with SLE can live active and fulfilling life which is a far cry from the continued regression that the PDA's legal advisor stated. Patients with SLE are expected to experience symptoms that occur on and off over their lifetimes, but will be expected to live normal and active lifespan; g. stated that the applicant's specialty as a physician does not automatically mean she is knowledgeable about medical retention standards or preparing medical profiles; and h. concluded that the PEB erred in concluding that her injury was not exacerbated by her Army service and did not base its conclusion on medical principle, thus making it not reasoned. 26. U.S. Code, Title 10, section 1201, states that upon a determination by the Secretary concerned that a member of the regular component of the armed forces entitled to basic pay, any other member of the armed forces entitled to basic pay who has been called or ordered to active duty (other than for training under section 10148(a) of this title) for a period of more than 30 days, any other member of the armed forces who is on active duty but is not entitled to basic pay by reason of section 502(b) of title 37 due to authorized absence to either participate in an educational program or for an emergency purpose, as determined by the Secretary concerned, is unfit to perform the duties of the member’s office, grade, rank, or rating because of physical disability incurred while entitled to basic pay, the Secretary may retire the member, with retired pay computed under section 1401 of this title, if the Secretary also makes the determinations that (1) based upon accepted medical principles, the disability is of a permanent nature and stable, (2) the disability is not the result of the member’s intentional misconduct or willful neglect, and was not incurred during a period of unauthorized absence; and (3) either the member has at least 20 years of service computed under section 1208 of this title; or the disability is at least 30 percent under the standard schedule of rating disabilities in use by the Department of Veterans Affairs at the time of the determination; and either: a. based upon accepted medical principles, the disability is of a permanent nature and stable; b. the disability is not the result of the member’s intentional misconduct or willful neglect, and was not incurred during a period of unauthorized absence; and c. (1) the member has at least 8 years of service computed under section 1208 of this title or (2) the disability is at least 30 percent under the standard schedule of rating disabilities in use by the Department of Veterans Affairs at the time of the determination; and either (i) the member has at least 8 years of service computed under section 1208 of this title; (ii) the disability is the proximate result of performing active duty; (iii) the disability was incurred in line of duty in time of war or national emergency; or (iv) the disability was incurred in line of duty after September 14, 1978. 27. Army Regulation 635-40 (Physical Evaluation for Retention, Retirement, or Separation) establishes the Army physical disability evaluation system and sets forth policies, responsibilities, and procedures that apply in determining whether a Soldier is unfit because of physical disability to reasonably perform the duties of his office, grade, rank, or rating. It provides for medical evaluation boards, which are convened to document a Soldier's medical status and duty limitations insofar as duty is affected by the Soldier's status. A decision is made as to the Soldier's medical qualifications for retention based on the criteria in Army Regulation 40-501 (Standards of Physical Fitness), chapter 3. If the MEB determines the Soldier does not meet retention standards, the board will recommend referral of the Soldier to a Physical Evaluation Board (PEB). 28. Paragraph 3-1 of Army Regulation 635-40 provides that the mere presence of impairment does not, of itself, justify a finding of unfitness because of physical disability. In each case, it is necessary to compare the nature and degree of physical disability present with the requirements of the duties the member reasonably may be expected to perform because of his or her office, rank, grade or rating. 29. Paragraph 3-2b(2) further provides that when a member is being separated by reason other than physical disability, his or her continued performance of assigned duty commensurate with his or her rank or grade until he or she is scheduled for separation or retirement creates a presumption that he or she is fit. This presumption can be overcome only by clear and convincing evidence that he or she was unable to perform his or her duties for a period of time or that acute grave illness or injury or other deterioration of physical condition, occurring immediately prior to or coincident with separation, rendered the member unfit. DISCUSSION AND CONCLUSIONS: 1. The applicant entered into the HPSP in 1992. She received financial support in exchange for future service as a physician. Subsequent to her completion of a medical degree in 1996, she entered into a civilian residency until 1999. During this residency, she was diagnosed with SLE. She entered the active Army and was entitled to basic pay in July 1999. 2. The applicant’s condition worsened during her pregnancy in 2004 due to discontinuing some of her medications and after she gave birth to her second child in September 2004, due to breastfeeding. Accordingly, she was furnished a permanent physical profile and placed on a reduced work schedule. 3. SLE is a chronic and potentially fatal connective tissue inflammatory disease in which immunological reactions cause abnormalities of blood vessels and connective tissue involving the joints, kidneys, nervous system, and skin. Webster's New World Dictionary describes lupus erythematosus as "usually a chronic inflammatory disease in which immunological reactions cause abnormalities of blood vessels and connective tissue; the systemic form commonly involves the joints, kidney, nervous system, and skin.'' 4. The applicant underwent a series of medical examinations, a MEB, and PEB. The PEB found her unfit for SLE, but considered it non-compensable because the condition was not incurred while entitled to basic pay and that her current state of unfitness was the result of natural progression of her condition. She non-concurred, but waived her right to a formal hearing. She submitted an appeal which stated that even though she was not on active duty when her SLE was incurred, she was obligated to serve in the Army after her civilian training. She further indicated that she believed her SLE was permanently aggravated while on active duty since 1999. The PEB reviewed the appeal, but found no new evidence which required a change to the PEB’s findings. 5. SLE is a chronic progressive disease process that is characterized by periods of illness. Although it can be managed by prescribed medications and medical treatment, the natural progression of SLE is for it to get worse. The fact that she discontinued her medications during her pregnancy and breastfed afterward, most likely would have caused her condition to progress regardless of her military status. 6. The applicant’s history of flares and slowly reduced work duties clearly support the findings of natural progression. The PEB reviewed the entire case and its conclusion was that her case was properly adjudicated and that the rules that govern the PDES in making its determination were correctly applied. The fact that the applicant was obligated for further military service because of her medical schooling at the time of her diagnosis with SLE does not establish her condition as service incurred or permanently aggravating. BOARD VOTE: ________ ________ ________ GRANT FULL RELIEF ________ ________ ________ GRANT PARTIAL RELIEF ________ ________ ________ GRANT FORMAL HEARING __xxx___ __xxx___ __xxx___ DENY APPLICATION BOARD DETERMINATION/RECOMMENDATION: The evidence presented does not demonstrate the existence of a probable error or injustice. Therefore, the Board determined that the overall merits of this case are insufficient as a basis for correction of the records of the individual concerned. XXX ______________________ CHAIRPERSON a. systematic lupus erthematosis, manifested by positive ANA, malar rash, oral ulcers, pleuritis, photosensitivity, arthralgias and fatigue; chronic and persistent; b. Fibromyalgia, chronic manifested by classis non-restoring sleep pattern, greater than 11/11 trigger points and fatigue; c. Depression associated with chronic systemic lupus erythematosis, chronic pain, and poor sleep and possibly related to familial history of depression. d. Patellofemoral syndrome, persistent but improved with physical therapy and quadriceps strengthening. e. Mitral valve prolapsed with associated mitral regurgitation requiring prophylactic antibiotics for surgical and dental procedures, stable. ABCMR Record of Proceedings (cont) AR20070018489 15 DEPARTMENT OF THE ARMY BOARD FOR CORRECTION OF MILITARY RECORDS 1901 SOUTH BELL STREET, 2ND FLOOR ARLINGTON, VA 22202-4508